Medicare expenditures for advanced dementia patients vary widely, study shows

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Implementing high-quality palliative care programs for nursing home residents with advanced dementia could prevent expensive hospitalizations and burdensome interventions, such as feeding tubes, a new study finds.

Due to a lack of data regarding end-of-life Medicare expenditures in nursing home patients with severe dementia, researchers from Columbia University, Harvard Medical School, Beth Israel Deaconess Medical Center and Hebrew SeniorLife Institute for Aging Research studied 323 residents at nearly two dozen nursing facilities over a period of 18 months. The total mean Medicare expenditures during that period were $2,303 per 90 days, but that number is highly skewed. Expenditures were less than $500 for 77% of assessments but more than $12,000 for 5.5%. Among the 177 study subjects who died, mean Medicare expenditures increased by 65% in each of the last four quarters before death due to an increase in hospice and acute care.

Patients living in specialized units, who did not have feeding tubes and who had do-not-hospitalize orders, had lower Medicare expenditures than those undergoing more aggressive treatments, the investigators found.

“Strategies that promote high-quality palliative care may shift expenditures away from aggressive treatments for these patients at the end of life,” wrote the researchers. The study was published in the Archives of Internal Medicine.

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